Affordable Care Act

[Clevy]

Originally Posted By: eljefino
One bit I'm cautiously optimistic about is the simplified bronze, silver, gold, platinum naming.

What would be a cool hybrid of public/ private is if this means Bronze from Blue Cross is exactly the same as bronze from Harvard Pilgrim. So a person could shop on price or perceived quality of in-network care.

Then someone could go online and ask, I'm getting X procedure done and I'm hitting the limit on my co-pay, but I still have these extra bills for durable medical equipment (or whatever), is this legit?

Then someone else could say, for silver, "no".

In other words, instead of having thousands of confusing contracts out there, there could be only four.

I know I've gotten explantions of benefits where I've felt bent over and screwed... from add ons and exceptions they build in on purpose.

If these get forced into the light of day and publicised, the public may find tools to fight this stuff off.



My point exactly. Expose the whole system to some scrutiny. Let the public have the ability to shop for the required service just like you shop for a contractor to renovate your home.
Compare what you are getting for services and what's covered so a person can grasp what they are paying for.

Canada's system is far from perfect but I can tell you that just knowing I won't have to sell my house if I get cancer or not getting treatment because I can't afford it is a stress no human being should have to feel.
Yeah we've got long wait times if you need an MRI and yeah wait times to see a specialist can be extended but at least the service is there for everyone.
When I first hurt my back I got a ton of investigative and exploratory stuff done. Then physio was a 14 week deal that cost 1000 a week because of how intensive it was. And cost to me was 0.
When I fell out of the man box and fell 45 feet to the ground the cat scan cost 10 grand alone. Ambulance was 4500 bucks. 3 day stay at the hospital for observation due to their concern of brain swelling was 1200 a day.
One thing that is for sure America has the absolute best possible equipment and are on the cutting edge as far as breakthroughs and the actual care itself,the only issue is the cost.
If I didn't have insurance I likely wouldn't even have gone to the hospital when I fell.

 

[DBMaster]

Originally Posted By: pbm
Lawsuits are one of the big factors driving up healthcare costs and the ACA doesn't even address tort-reform.


Litigation drives up the costs of just about everything. That is a societal issue that we have procrastinated dealing with in any meaningful way. I do know that no truly meaningful proposals came from the group that tried to shut down the ACA. I don't like conspiracy theories, but there are A LOT of groups out there with vested interests in not bringing about meaningful change.

But, isn't that the way it is with almost any meaningful change? Some will be happy, some will not. It will cost some more money than now and some less. Some will have better outcomes, some worse. Just about any sort of program for the public good is going to be aimed at improving something for the majority. And, most importantly, many public policies do exacerbate the very issues they are intended to ameliorate.

Here it comes; my big opinion statement. It is far worse to do nothing than to try. The road we are on is the honoring of a campaign pledge that has been hard fought. The electorate is wishy-washy and wants everything in exchange for giving nothing. What has happened to this country?

 

[hattaresguy]

Originally Posted By: DBMaster
I want to make sure I don't come across as being 100% pro-ACA. The major exciting thing about it, to me, is that after over 40 years of discussion, reform has actually come. Just like Medicare in 1965, there is a lot of controversy. Medicare is practically a birthright now, but it has existed for less than 50 years!

The ACA is just a first step in what will be many. I think it has been well overdue. We MUST remove this barrier to workforce mobility. How many are stuck in jobs they hate due to health insurance reasons? How many postpone retirement because they are not of Medicare age yet? How many end up strapped, or broke, due to a major illness that hits during a time when it is most likely to occur - during the stress of a job loss?

Whether or not this is the best system - how could it be? - it is a step. We have had a form of "socialized" medicine for a long time. You just haven't thought about it. I see plenty of posts above talking about how the rest of us pay the costs of those who cannot pay. Do you like doing that? The same folks who "can't afford" medical care, especially preventive care, seem to be able to afford new cars, big TV's, iPhones, beer, cigarettes, pot, you name it. Nobody wants to give up anything to pay for what is probably one of the most important things in life.

I, for one, am extremely tired of seeing my costs go up every year, faster than the rate of inflation by several times, because a substantial group is choosing to shirk responsibility.


This is why Germany is beating our brains out with high skill and high paying jobs. Germans don't have to worry about health insurance so are very job mobil.

This is why say an air filter for a Mercedes is made in Germany by a unionized worker making probably $60k a year, and one for a Ford is made in Mexico by someone making $5 an hour.

 

[hattaresguy]

Originally Posted By: pbm
Lawsuits are one of the big factors driving up healthcare costs and the ACA doesn't even address tort-reform.


No one is saying the ACA is perfect or even in its final form, but its a step in the right direction. Once everyone gets to pay in, they will have more of a vested interest in reducing costs.

 

[Mykl]

I know how easy it is to politicize this topic, and I'm going to offer my take on why this is the ACA is not addressing the core problem as I see it. I hope this isn't seen by anybody as political simply because it appears as though no politician on any side seems to be taking this stance. This has nothing to do with Democrats or Republicans, liberals or conservatives, I just want to offer some information on the state of our health care system.

Health care cost comparisons...
http://www.washingtonpost.com/blogs/wonk...-are-ludicrous/

Hospital and insurance company interactions...
http://www.forbes.com/sites/peterubel/2012/10/01/are-insurance-companies-the-key-to-lower-prices/

So without creating too wordy a post with too many links, my theory is that the hardball hospital and insurance company negotiations have created an unrealistic pricing situation that no individual can possibly handle.

The problem isn't some people's lack of insurance, the problem is that pricing has risen to such insane levels that an individual is completely incapable of paying for services out of pocket.

So maybe instead of trying to get everybody signed up with an insurance company, somebody needs to ask these hospitals why their prices are out of control and so insanely out of proportion with other countries. Solve that problem and it won't matter if some don't have insurance.

 

[Blaze]

A good friend of mine with no health insurance went into cardiac arrest this past summer while driving. Fortunately he is alright but was stuck with a 145K bill for his new pacemaker etc. He went to an experienced bankruptcy attorney after he got the bill. His attorney told him to sit tight and work with the hospital. After meeting with the hospital they brought the bill down to 12K and he then brought the bill to his attorney to look over the itemization. The attorney told him settling with the hospital at 12K they still make money. The attorney told him their break even point was closer to 8-9K and keeping in mind the original bill started out at 145K!!

 

[javacontour]

I think you've hit on a key component of all of this.

Anytime Other People's Money is in play, prices are distorted.

This includes where money is artificially cheap such as the recent mortgage backed securities collapse, rising college tuition costs, and going back as far as the stock market crash in 1929.

In all of these cases, leverage is used and the money was not priced property according to the risk.

Health care is in the same boat. Few are spending their own money. Not doctors, not hospitals, not patients. They all bill a third party.

I don't see how we address this by having a different third party.

It's not a political issue. It's a cultural issue. We have folks who think it's ok to expect others to pay the way for some.

We've gone from health insurance handling catastrophic issues to people expecting their health insurance to pay for every possible service and procedure.

It will become yet another too big to fail piece of our economy. No one is responsible, but everyone has to pay.

I don't think either party has a solution. All we have is a band-aid being applied to what appears to be a fiscal and social sucking chest wound.

Some love the band-aid, others are critical, but none can or will address the underlying issue the band-aid is trying to treat.

Originally Posted By: Mykl
I know how easy it is to politicize this topic, and I'm going to offer my take on why this is the ACA is not addressing the core problem as I see it. I hope this isn't seen by anybody as political simply because it appears as though no politician on any side seems to be taking this stance. This has nothing to do with Democrats or Republicans, liberals or conservatives, I just want to offer some information on the state of our health care system.

Health care cost comparisons...
http://www.washingtonpost.com/blogs/wonk...-are-ludicrous/

Hospital and insurance company interactions...
http://www.forbes.com/sites/peterubel/2012/10/01/are-insurance-companies-the-key-to-lower-prices/

So without creating too wordy a post with too many links, my theory is that the hardball hospital and insurance company negotiations have created an unrealistic pricing situation that no individual can possibly handle.

The problem isn't some people's lack of insurance, the problem is that pricing has risen to such insane levels that an individual is completely incapable of paying for services out of pocket.

So maybe instead of trying to get everybody signed up with an insurance company, somebody needs to ask these hospitals why their prices are out of control and so insanely out of proportion with other countries. Solve that problem and it won't matter if some don't have insurance.

 

[Mykl]

Originally Posted By: javacontour
I think you've hit on a key component of all of this.

Anytime Other People's Money is in play, prices are distorted.

This includes where money is artificially cheap such as the recent mortgage backed securities collapse, rising college tuition costs, and going back as far as the stock market crash in 1929.

In all of these cases, leverage is used and the money was not priced property according to the risk.

Health care is in the same boat. Few are spending their own money. Not doctors, not hospitals, not patients. They all bill a third party.

I don't see how we address this by having a different third party.

It's not a political issue. It's a cultural issue. We have folks who think it's ok to expect others to pay the way for some.

We've gone from health insurance handling catastrophic issues to people expecting their health insurance to pay for every possible service and procedure.

It will become yet another too big to fail piece of our economy. No one is responsible, but everyone has to pay.

I don't think either party has a solution. All we have is a band-aid being applied to what appears to be a fiscal and social sucking chest wound.

Some love the band-aid, others are critical, but none can or will address the underlying issue the band-aid is trying to treat.


As my theory goes, at least in my own head... the lobbyists for both the insurance companies and health care organizations have to be extremely well funded and powerful.

This gives me the feeling that no politician on any side of this is really seeing this for what it is given the influence of said lobbyists. I'm guessing that those politicians that do see this as a problem lack the political power to do anything about it, because again... lobbyists and influence on their fellow politicians.

 

[eljefino]

Originally Posted By: pbm
Lawsuits are one of the big factors driving up healthcare costs and the ACA doesn't even address tort-reform.


If you have "a thing done" and the doctor screws up and you're disabled, you then have to sue him to cover your lost income until you retire.

And since you won't have health insurance without a job, you have to cover that, too, and all your medical bills.

If this were covered, it wouldn't be on the list of damages your lawyer would demand, and malpractice insurance premiums should decrease on the "back end."

But we have such a jolly good time deciding which insurance pays, we forget it snakes its way back to "society."

If I drive for work and get hurt in a wreck, is it my health insurance, my car insurance, the other party's car insurance, or worker's comp? It's nuts!

 

[itguy08]

Originally Posted By: Clevy

Canada's system is far from perfect but I can tell you that just knowing I won't have to sell my house if I get cancer or not getting treatment because I can't afford it is a stress no human being should have to feel.


Yes but you trade that for lesser care. I remember reading about the UK and I believe Canada's systems where after a certain age you can't get things like dialysis, cancer treatment, etc. That's a little crazy that, say a 70 year old (who may have another 10-20 years) can't get treatment that they need. One could say they don't have to worry about it because they won't live long enough to worry about it.

There are places for people to go who can't afford their meds. When my Mom needed a certain Breast Cancer med that, IIRC was like $3k a week, she was worried about her and Dad would loose their house, savings, etc. Instead of worrying, she called up the drug company and went through the paperwork to get the medicine at a reduced free cost (forget which).

IIRC my Mom was in her late 50's when she got Breast Cancer. Up until the day she couldn't tolerate it any more she was getting chemo, radiation, etc. and generally got the best care for her advanced cancer. Ended up living another 10 or so years while getting some very expensive treatments. Would that have happened under a "socialized" system?

 

[whip]

Originally Posted By: pbm
Lawsuits are one of the big factors driving up healthcare costs and the ACA doesn't even address tort-reform.

Would the fact that it's mostly lawyers that write our laws have anything to do with that?

As far as the ACA goes, I'm taking a wait and see approach. It can't be much worse than what we have now. Can it?

 

[whip]

Originally Posted By: Blaze
A good friend of mine with no health insurance went into cardiac arrest this past summer while driving. Fortunately he is alright but was stuck with a 145K bill for his new pacemaker etc. He went to an experienced bankruptcy attorney after he got the bill. His attorney told him to sit tight and work with the hospital. After meeting with the hospital they brought the bill down to 12K and he then brought the bill to his attorney to look over the itemization. The attorney told him settling with the hospital at 12K they still make money. The attorney told him their break even point was closer to 8-9K and keeping in mind the original bill started out at 145K!!

This is one of the problems I have with the current system. If your friend had insurance, the bill would have only been about $30,000. Why do the insurance companies get a reduced rate, but I have to pay full price if I don't?

 

[Mykl]

Originally Posted By: whip
Originally Posted By: Blaze
A good friend of mine with no health insurance went into cardiac arrest this past summer while driving. Fortunately he is alright but was stuck with a 145K bill for his new pacemaker etc. He went to an experienced bankruptcy attorney after he got the bill. His attorney told him to sit tight and work with the hospital. After meeting with the hospital they brought the bill down to 12K and he then brought the bill to his attorney to look over the itemization. The attorney told him settling with the hospital at 12K they still make money. The attorney told him their break even point was closer to 8-9K and keeping in mind the original bill started out at 145K!!

This is one of the problems I have with the current system. If your friend had insurance, the bill would have only been about $30,000. Why do the insurance companies get a reduced rate, but I have to pay full price if I don't?


Because insurance companies have bargaining power, you don't unless you hire third party representation. It's wrong, innocent people are getting caught up in this pricing war between the insurance companies and health care providers.

 

[DBMaster]

Originally Posted By: javacontour
I think you've hit on a key component of all of this.

Anytime Other People's Money is in play, prices are distorted.


Way to put it succinctly! I believe similar forces are at play with college costs.

 

[Clevy]

Originally Posted By: itguy08
Originally Posted By: Clevy

Canada's system is far from perfect but I can tell you that just knowing I won't have to sell my house if I get cancer or not getting treatment because I can't afford it is a stress no human being should have to feel.


Yes but you trade that for lesser care. I remember reading about the UK and I believe Canada's systems where after a certain age you can't get things like dialysis, cancer treatment, etc. That's a little crazy that, say a 70 year old (who may have another 10-20 years) can't get treatment that they need. One could say they don't have to worry about it because they won't live long enough to worry about it.

There are places for people to go who can't afford their meds. When my Mom needed a certain Breast Cancer med that, IIRC was like $3k a week, she was worried about her and Dad would loose their house, savings, etc. Instead of worrying, she called up the drug company and went through the paperwork to get the medicine at a reduced free cost (forget which).

IIRC my Mom was in her late 50's when she got Breast Cancer. Up until the day she couldn't tolerate it any more she was getting chemo, radiation, etc. and generally got the best care for her advanced cancer. Ended up living another 10 or so years while getting some very expensive treatments. Would that have happened under a "socialized" system?


You are mistaken on your point about age dependent care. My grandmother was on dialysis until she died when she was 92.
The care provided is triage type. If a patient needs it and its a potential life or death issue they get seen immediately,pushing someone who is less in need back.
Your entire post is incorrect as far as our system. As far as meds go here the provincial government subsidizes prescriptions based on income. A person with an income of for example 30000 a year will only pay roughly 20% of actual cost. A persons income dictates what percentage of actual cost they pay for prescriptions. And it's not a buy now then get a refund type system. You pay the lesser amount at the till.
There are a lot of inaccuracies floating around America about our health care system. Most of the misinformation is parroted by people trying to sell or push an agenda and they try to cite examples of the shortcomings of our system when the truth is more complicated.
Age and health have no bearing on what care a patient will receive nor affect whether a patient will be able to have any necessary procedure.
Some patients make a choice to not have a procedure done because they feel they are too old though but that in no way means they aren't eligible for it.

 

[Blaze]

Originally Posted By: Mykl
Originally Posted By: whip
Originally Posted By: Blaze
A good friend of mine with no health insurance went into cardiac arrest this past summer while driving. Fortunately he is alright but was stuck with a 145K bill for his new pacemaker etc. He went to an experienced bankruptcy attorney after he got the bill. His attorney told him to sit tight and work with the hospital. After meeting with the hospital they brought the bill down to 12K and he then brought the bill to his attorney to look over the itemization. The attorney told him settling with the hospital at 12K they still make money. The attorney told him their break even point was closer to 8-9K and keeping in mind the original bill started out at 145K!!

This is one of the problems I have with the current system. If your friend had insurance, the bill would have only been about $30,000. Why do the insurance companies get a reduced rate, but I have to pay full price if I don't?


Because insurance companies have bargaining power, you don't unless you hire third party representation. It's wrong, innocent people are getting caught up in this pricing war between the insurance companies and health care providers.


All this fits in with what a poster just mentioned "playing with other peoples money".

 

[DBMaster]

I actually used to manage dialysis clinics. A topic that came up often was the comparison between the morbidity and mortality rates of ESRD (end stage renal disease) patients in the US v. other countries. In this country, Medicare pays for dialysis and related meds for ANY age patient - after a waiting period. How did that happen? Check out the ESRD Act of 1972. Morbidity and mortality rates for ESRD patients in the US are worse than in other first world countries primarily due to the fact that we pay for dialysis for anyone. In other countries where the taxpayers foot the bill they look at mitigating factors - not just age! When you are the point at which dialysis is needed it is most likely going to merely extend life and not improve it. Also, most ESRD patients in the US became that way by ignoring their health until it was too late. Not all fall into this category, just the vast majority. The last time I cared to know - 1996 - Medicare spent over $6 billion on dialysis treatments for ESRD patients. I worked for both of the largest providers in the industry and I can tell you that the patient population continues to grow. If you have diabetes or hypertension and don't take exceptionally good care of yourself this is where you are headed.

 

[PandaBear]

Originally Posted By: cchase
I don't really care about political side of things, but I don't want health insurance and don't want someone telling me I have to get it.


So, if and when you get so sick who is paying for your care?

Of course, them greedy hospitals and doctors will charge ME higher so they can do it for free to people like you.

 

[PandaBear]

Originally Posted By: Blaze
A good friend of mine with no health insurance went into cardiac arrest this past summer while driving. Fortunately he is alright but was stuck with a 145K bill for his new pacemaker etc. He went to an experienced bankruptcy attorney after he got the bill. His attorney told him to sit tight and work with the hospital. After meeting with the hospital they brought the bill down to 12K and he then brought the bill to his attorney to look over the itemization. The attorney told him settling with the hospital at 12K they still make money. The attorney told him their break even point was closer to 8-9K and keeping in mind the original bill started out at 145K!!


Because out of 10 people that are charged with 145K, 1 or 2 pay the 12K and 8-9 just walk away paying none.

We waste 1/3 of medical expense on administrative things for this kind of nonsense, about finding out who can pay and how much can they pay.

 

[PandaBear]

Originally Posted By: itguy08
IIRC my Mom was in her late 50's when she got Breast Cancer. Up until the day she couldn't tolerate it any more she was getting chemo, radiation, etc. and generally got the best care for her advanced cancer. Ended up living another 10 or so years while getting some very expensive treatments. Would that have happened under a "socialized" system?


This is one of the fundamental reason why medical cost in the US is so high, if you eliminate the free loaders (i.e. illegal and uninsured).

In other nations, you don't get advance drugs that is still has unexpired patents unless you pay for it yourself. In the US with insurance, you do, and recently we started covering that in Medicare Medicaid too, and the cost skyrocketed.

Other nations that does not cover it has much lower prices due to the government's bargaining power and patients' affordability. In the US with health insurance, we don't and end up paying for whatever they ask for unless you are broke.

So, as a result, we subsidized the big pharmas' profits and their R&Ds on more of these drugs later on, for better or worse. The rest of the world pay a much smaller share of this expense.